That’s what often comes up when we’re engaged with the community, talking with individuals and families. One of the biggest challenges in the public health crisis of increasing suicide rates is stigma that is not only felt by those who courageously admit that they have contemplated, planned or attempted suicide, but that also attaches to the families of victims.

Suicide is a complex problem and things are changing. In the late 1990’s, statistics were often quoted that emphasized the connection of mental illness and suicide; today, we know that mental illness is only one part of the picture. Again, it’s complex. Now, according to NAMI (National Alliance on Mental Illness) in 2016, 54 percent of suicides were by persons without diagnosed mental illness.

It leaves me wondering what are the other reasons for suicidal ideation and how can we, as a community; create a place of safety and trust to share those concerns, those very challenges that turn into isolation and disease, contributing to escalating suicide rates.

In Marin County alone, suicide rates for 2014-16 were more than double the statewide average, according to the California Department of Public Health’s Status Profile for 2017. It’s important to note that suicides may go unreported, appearing as homicides or accidents. One reason for this has to do with specific cultural norms of acceptability. In other words, there is more at play than a generic blanket of stigma. Stigma itself is a complicated, a culturally influenced construct, sharing the themes shame and guilt.

The remedy is neither quick nor compact.

When we deconstruct the apparent causes of suicide it’s well established that the complexity has many tributaries. Consider factors like social determinants of health; certain populations are at greater risk. This risk may include adverse childhood experiences, economic and social trends, as well as life events. In essence, everything from social media, the stress of college admissions applications to bankruptcy and break-ups can, in some situations, increase thoughts of suicide.

How do we create a safe space in the landscape of a curated “Instagram” lifestyle to be able to talk honestly about our feelings?

While the overall solutions may be as complex as the problem, requiring active partnership of government, faith, schools, workplace, families and friends, there are tools that are available to everyone, including support for those “uncomfortable conversations.”

Learning to talk skillfully and listen well are ground zero in suicide prevention. Those simple, informed acts help remove the stigma of discussing suicide; normalizing a wide range of feelings we all have — fear, loneliness, anger and frustration. Those conversations can also increase the safe place between a thought and an action.

Available to everyone are tools such as “Know the Signs,” a suicide prevention program sponsored by the California Mental Heath Services Authority and the North Bay Suicide Prevention Hotline — 415-499-1100 — which fielded 16,000 calls last year. The hotline receives calls from not only those in crisis, but also from individuals who are concerned about a family member, friend or coworker.

This September as we acknowledge suicide prevention month, I encourage you to take a minute, know the signs, remembering always that we are not alone. Let’s make time to talk about it. Let’s ask the question.